MRONJ

Question 1

what is MRONJ

Answer 1

rare side effect of anti resorptive or anti angiogenic drugs
exposed bone that has persisted for more than 8 weeks in patients with a history of treatment with anti resorptive or anti angiogenic drugs, where there has been no history of radiation therapy and no obvious metastatic disease to the jaws

Question 2

symptoms of MRONJ

Answer 2

can occur spontaneously but majority occur following dental treatment
- delayed healing
- pain
- soft tissue infection
- swelling
- numbness/ paraesthesia
- exposed bone

(asymptomatic presentation is possible)

Question 3

how do bisphosphonates work

Answer 3

reduce bone resorption by inhibiting enzymes essential for formation recruitment and function of osteoclasts

Question 4

how does denosumab work

Answer 4

RANKL inhibitor (anti resorptive)
inhibits osteoclast formation

Question 5

what 4 things make a patient high risk of MRONJ

Answer 5

• oral or IV bisphosphonates for > 5 years
• bisphosphonates or denosumab in combo with systemic glucocorticoids
• anti resorptive or anti angiogenic drugs for cancer treatment
• previous MRONJ

Question 6

when should an extraction socket in a patient at risk of MRONJ be reviewed

Answer 6

8 weeks post extraction (MRONJ = exposed bone for >8 weeks)